Provider Demographics
NPI:1003595679
Name:MITERKO, AMY HELEN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HELEN
Last Name:MITERKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 N COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1313
Mailing Address - Country:US
Mailing Address - Phone:570-424-8065
Mailing Address - Fax:570-424-8092
Practice Address - Street 1:695 N COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1313
Practice Address - Country:US
Practice Address - Phone:570-424-8065
Practice Address - Fax:570-424-8092
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician